Healthcare Provider Details

I. General information

NPI: 1285558262
Provider Name (Legal Business Name): YAMAID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 FOUR MILE RD APT 713
ALEXANDRIA VA
22305-2020
US

IV. Provider business mailing address

511 FOUR MILE RD APT 713
ALEXANDRIA VA
22305-2020
US

V. Phone/Fax

Practice location:
  • Phone: 702-303-9722
  • Fax:
Mailing address:
  • Phone: 702-303-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. YADO KABEMBA KABUYA SR.
Title or Position: MANAGER
Credential: VA
Phone: 702-303-9722